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It’s Only Free If You’re Not Getting Sick

I have now posted a notice in my office and each exam room stating exactly what Obamacare will cover for those yearly visits. Remember Obama promised this as a free exam — no co-pay, no deductible, no charge. That’s fine and dandy if you are healthy and have no complaints. However, we are obligated by law to code specifically for the reason of the visit. An annual exam is one specific code; you can not mix this with another code, say, for rectal bleeding. This annual visit covers the exam and “discussion about the status of previously diagnosed stable conditions.” That’s the exact wording under that code — insurance will not cover any new ailment under that code.

If you are here for that annual exam, you will not be covered if you want to discuss any new ailment or unstable condition. I cannot bait and switch to another code — that’s illegal. We, the physicians, are audited all the time and can lose our license for insurance fraud.

You, the patient, will then have to make a decision.

Do you want your “free” yearly exam, or do you want to pay for a visit which is coded for a particular, new problem? You can have my “free” exam if you only discuss what Obamacare wants me to discuss… If you are complaining of a new problem, then you have to reschedule, since Obamacare is very clear as to what is covered and what is not. Obamacare — intentionally — makes it as difficult to be seen and taken care of as possible.

It really is as cynical as its proponents always called Big Insurance.

Hey, who needs a “death panel” if people die waiting on an appointment?

36 thoughts on “It’s Only Free If You’re Not Getting Sick”

By coincidence I’ve just read James C. Scott’s Seeing Like a State. Scott is a highly regarded political scientist with the usual gunny-sack full of academic awards. Scott Teaches at Yale these days. He is some kind of anarchist, or at least he has anarchist principles. He has spent most of his career studying how agrarian people resist modern governments.
In the book — which is subtitled “How certain Schemes to Improve the Human Condition Have Failed” — Scott talks quite a bit about ‘legibility’, the phenomenon of the modern state knowing a great deal more about the people and the lands they rule compared to pre-modern times, and how this leads to hubris. City-dwellers are rounded up and made to live on farms in the countryside, farmers are rounded up and made to move into villages. poverty, starvation, war, and death are often the result.
From near the book’s end:

We have examined in considerable detail how these schemes have failed their intended beneficiaries. If I were asked to condense the reasons behind these failures into a single sentence, I would say that the progenitors of such plans regarded themselves as far smarter and farseeing than they really were and, at the same time, regarded their subjects as far more stupid and incompetent than they really were.

The questions that need to be answered are:
1. How large an economic transfer should be made from working people to the elderly? Is the government acting simply to reduce poverty, or to accomplish some other objective through universal entitlements?

3. How much should individuals be forced to share in the cost of health care for others? How much should an individual have to pay before the government helps pay their health care bills?

I think Obamacare will put us in a situation where 90% of the population will be on government subsidized healthcare by 2020. By that point, some form of cost control will be essential. I think the best option is probably to put the onus on doctors’ groups to reduce costs by offering them a set annual fee per patient based on that patient’s age and any chronic ailments. There will still be problems, and the correct level of regulation will be hard to judge. But medicine will never be a perfect market, and market solutions alone will never produce a workable and humane system

American business will dump health care even if it’s just a break even proposition for them. Providing health care is a tremendous distraction for business. It gets employers involved in aspects of the employees’ lives where they don’t belong and aren’t comfortable. Much as you don’t want your employer making life or death decisions about coverage for one of your family members, your employer really doesn’t want to be in that position either. I fully expect to see a trickle of businesses, starting with small ones, dropping their employees onto the exchanges, which will grow to an avalanche. Health care insurance from your employer will become rare.

Which makes the structure of the health care bill so poor. By charging a penalty per employee, the health care bill creates an incentive to minimize the number of employees, work them as many hours a week as you possibly can, burn them out, then fire them and hire someone new. In other words, just like the current system. If you feel the need to tax compensation, then make it a fixed percentage. Better yet, put in a national value added tax to pay for health care and tax consumption.

The Republicans are very unlikely to repeal the health reform law. But they could improve it by paring back the minimum plan to a high deductible, high co-pay plan with a maximum on the co-pay.

In general, businesses would be better off if they got out of the benefits business and paid only in cash. All forms of compensation should be taxed with no exemptions.

Bosshoss-
Scott is sympathetic to Left anarchist beliefs. He believes that the pricing mechanism of the market eventually forces the same errors as the utopian dreams of the authoritarians. The only certain way to keep decreasing costs is by increasing economy of scale. At some point the individual consumer, with his quirky tastes, becomes an impediment to making money (ever try to buy size 11 1/2 shoes at Walmart?).
I think that Scott would use the example of the nearly vanished American family farm: it was done in by capitalism, not the utopian scheme of a government bureaucrat.

Nobody will be more inconvenienced by BammyCare than all those wealthy Canadians that have been depending on US health care services for their life or death needs….gonna cost ’em plenty to bump granma down the list for that MRI, eh?

This is what is going on. There is too much inflation, taxes, and asset bubbles for the average person to take care of himself so the government has to do it. The government, however, is running out of money because the economy is mucked up by too much inflation, taxes, and asset bubbles. Any questions?

Listen to the 9/ 17 21 24 2012 and 11/ 29 2011 Coffee and Markets Podcasts. It’s all in there. Listen to the recent EconTalk about public pensions, too.

High growth is the only hope. That would have taken the edge off of deleveraging. Could have had that with Romney, short term it could have been fueled by fossil fuel exploitation.
‘Root, hog, or die’ time is getting closer.

I’m confused. People who voted for Obama this fall said that we should keep Obamacare as all it is is mandated insurance. That it has nothing to do with the government controlling the details of our healthcare. Surely DC bureaucrats aren’t dictating the details of my healthcare.

As is the case in all countries with socialized medicine, the care will ultimately be rationed. Recently, there has been public discussion about the group of bureaucrats that the Obumbler administration has assembled to essentially play God and decide what value a person needing say a liver transplant, will bring to society. I would hate to have some moron deciding that, just because of my age, my use to society isn’t worth that liver, therefore, I am put at the bottom of the list, probably dying before I’m even close to the top. The libturds screamed that Michele Bachmann’s warnings of death panels, were the ravings of a lunatic, but, just like her warning that radical Muslims were infiltrating our government, are proving to be correct, i.e. Keith Ellison. The left hates it when their agendas are exposed, but then they rely on their useful idiots to swallow their bull and ignore their lying eyes and ears.

Funny thing, the definition the doc finds so offensive is exactly the same definition of an annual exam currently used by practically all health insurance companies that offer “free” annual exams that I’ll bet he provides and appropriately codes every day. All of a sudden, however, it’s offensive and objectionable. The only thing that surpasses your ignorance is your disinginuity.

Mitch says the “author objects to is the fact that this exam is being sold to the general public – who don’t understand medical coding – as something it’s not”

But neither Mitch nor the author provide any evidence that this is the case. In fact the author says “almost all are supportive and totally understand” the ACA policy as explained to them by the doctor. If the free annual preventive visit benefit had been sold to the public as something else, we would expect the doctor to have muliple complaints when he enforced the correct policy. Is there any evidence of widespread missunderstanding of the new benefit?

“The only thing that surpasses your ignorance is your disinginuity.” Why the personal attack “drkensalerno”? (BTW, I think the word you meant to write was “disingenuousness”.)
Among the many reasons Hostess went out of business were work rules agreed to by the company and enforced by their contracts with the various unions. One of these including that a driver delivering cake couldn’t also deliver bread. This lead to inefficient routes that compounded Hostess financial troubles as their market share slid. Many people would think – “that’s dumb, just have the driver deliver both while he’s in the same location – less trips, less fuel, less time, etc.”
By the same token, many people might go to this doctor for their ‘free’ annual exam and think since they are there anyway, why not ask about items not covered in the mandated exam or ask to be treated for an ailment above and beyond the exam? Seems more efficient than having to come back. Plenty of businesses post notices to their customers about their terms that likely apply to few actual customers, but allow the put upon cashier or server not to have to tell the customer ‘no’.
I imagine that the doctor would refer the patient to the proper specialist or ask them to reschedule another appointment to resolve the ailment (as they might do currently with private insurance – you could be a help here “drkensalerno” by pointing out what your practice does currently and what your practice will do with the implementation of the ACA). The author is merely making his patients aware that he can’t treat their ailment or resolve issues not related while they are they are receiving their ‘free’ exam.
Also, RickDFL, a closer reading of the passage you excerpted – “almost all are supportive and totally understand” – lead me to the authors meaning that the doctors patients support and understand “why he put the sign up” after he explains it to them.

Just one question doc salerno; if you are actually a doctor, did you actually read the health care bill? If so, did you need to get your lawyer involved to understand many portions of it? Again, if so, were you not furious over all of the gotchas that never were presented to the American people? If you haven’t read and understand the ramifications of it, then I would say that you are the ignorant one. And, before you come back with the standard liberal answer, “well, no, but I got an overview;” that isn’t good enough. In fact, most doctors that I have discussed this very topic with, including three in my doctor’s practice, are thinking of closing shop because of it.

“Is there any evidence of widespread missunderstanding of the new benefit?”

Hard to notice a misunderstanding of anything when you live your life surrounded by fellow dimwits competing for the honor of being recognized as the most accurate papspew regurgitator in the swamp.

And if drkensalerno is an example, the only doc I’ll be visiting are ones that refuse to accept government medical chits. Let the dolts that believe they’re getting “free” exams enjoy the quality that buys…I’ll pay for the real deal.

Seflores, supporting and understanding “why he put the sign up” implies, conversationally if not logically, that it did not contradict their understanding of the ACA policy. If people thought that the sign contradicted their understanding of the ACA, they would object to the sign. Neither the Dr., Mitch, nor you provide any examples of any patient who had an incorrect interpretation of the new ACA policy.

I am not sure I understand your Hostess analogy. You seem to suggest that people will be confused and upset by the new ACA policy because it would be more convientient and effiicient for them if it covered treatment for new problems. In other words, because the ACA makes A free and it is convienient and efficient to get B at the same time as B, they will expect to get B free too.

But that seems silly. People are perfectly aware that a free product offer comes with lots of limits and restrictions on what is free. Just because a restaurant offers a free soda, I don’t expect to get the hamburger for free. I can order a hamburger when I pick up my free soda, but I still expect to pay for it.

Swiftee says: “Hard to notice a misunderstanding of anything when you live your life surrounded by fellow dimwits competing for the honor of being recognized as the most accurate papspew regurgitator in the swamp.” That seems like a harsh way to describe the inability of the Dr., Mitch, and Seflores to produce such evidence.

“the only doc I’ll be visiting are ones that refuse to accept government medical chits.” That rules out just about every Doc in the country, so Bon Voyage to the Hereafter.

“That rules out just about every Doc in the country, so Bon Voyage to the Hereafter.”

Pretty big statement there, Ricky. Where’s your proof, because I would venture to guess that many are going to rebel against the system any way that they can. Which begs the question, have you asked YOUR doctor what he’s going to do? It would be poetic justice if he told you that he was a. going to impose limits on the number of Medicare patients that he sees, b. just flat out isn’t going to see them at all or c. is getting out of doctoring and getting a job as a lobbyist for a pharmaceutical firm.

Looking for “das effidence” and “ve vant names off das suspekts, Herr Doktor” on the 70th anniversary of the release of “Casablanca”- RickDFL, I think you’re too romantic to be a regime defending thug. Although the way you joined the pig pile on Tim Russerts’ corpse at Ezra Klein’s old site the day Russert died argues against this.
Since we disagree on what the Doctor meant and you are demanding evidence as well, here’s a couple of examples from the article…
1. “This happened to me personally, as a patient, when I went for my physical.” – Namen: Dr. Peter Weiss (Weiss!?!). Social Security Number – unknown to me, but perhaps you’ll get it when you are tattooing it on his arm.
2. “The very few who complain? The same patients who always ask for free samples, who always complain that we do not validate parking.” Namen: unknown to me, and probably not legally disclosed by Dr Weiss due to various patient privacy laws. Given the governments disregard for privacy – both on purpose and by accident – you should have the names and identification numbers of these complainers soon enough.
Hostess example – one of the country’s largest bakers undone by management that couldn’t change products or distribution, and inefficient work rules. The ACA – inefficient, encumbered by many rules and one size fits all requirements.
As for your example about free products – have you ever given away something for free at a tradeshow or fair? I was once in a booth where we gave away free penlights with our logo to anyone that stopped by. The marketing people who sent the penlights did not include the little AAA battery. More than a few people (sorry, Rick, no names were entered into evidence) were ticked off when they asked for batteries for their ‘free’ flashlight and were told that we couldn’t provide them. These folks weren’t quite as understanding as you Rick with your Hamburger (more German!) example.
Good Luck! Sorry, make that Viel Glück.

There is a fair amount of argument on the left wing sites about this article. Many claim that this Doctor is just another RWNJ who is wrong about everything. His argument, that he can’t code anything beyond the Annual Wellness Visit as part of his billing to Medicare is correct. The Left Wing Crack Pots (LWCP) are claiming he can go above and beyond that “if he wants to”. I’m guessing they mean if Dr Weiss wants to work for free, he can. (Sounds black market and therefore verboten to me RickDFL).
But, according to one document provided by the Colorado Insurance exchange, doctors can code (and be reimbursed) for something that is discovered as part of the wellness exam. Dr. Weiss’ complaint about patients coming in for wellness exams and wanting to be treated for something else notwithstanding, he can be reimbursed for additional services although there appear to be a number of hoops he and or his billing coders have to jump through. It does appear that he cannot bill for additional services if the patient came in for a wellness exam and a wellness exam alone.

Jesus, no wonder these patients are pissed at their doctors and asking for additional services – Obama oversold and under-delivered on this ‘free wellness visit’. Here is what you get (from a form letter the AAFP has provided to their member providers)…

“Medicare does not pay for a traditional, head-to-toe physical. Medicare does pay for a wellness visit once a year to identify health risks and help you to reduce them. At your wellness visit, our health care team will take a complete health history and provide several other services:
-Screenings to detect depression, risk for falling and other problems,
-A limited physical exam to check your blood pressure, weight, vision and other things depending on your age, gender and level of activity,
-Recommendations for other wellness services and healthy lifestyle changes.
Before your appointment, our staff will ask you some questions about your health and may ask you to fill out a form.
A wellness visit does not deal with new or existing health problems. That would be a separate service and requires a longer appointment. Please let our scheduling staff know if you need the doctor’s help with a health problem, a medication refill or something else. We may need to schedule a separate appointment. A separate charge applies to these services, whether provided on the same date or a different date than the wellness visit.

Seflores wrote:Although the way you joined the pig pile on Tim Russerts’ corpse at Ezra Klein’s old site the day Russert died argues against this.
RickDFL does have a history of unleashing his big mouth online, doesn’t he? In comments at SITD he has told me that government takeover of healthcare would be just like getting a check for $2400 every year, that he wasn’t a defeatist regarding Iraq because we had already lost (this was in 2006), and that doctors conspired to keep their wages high by limiting the number of med school graduates. Ironically, this tool — restraint of trade — is what labor unions use to artificially inflate their members wages.

Seflores: I suppose in the realm of the irrational, asking for factual evidence looks like Nazi persecution.
1. In Dr. Weir’s, “this happened to me personally”, it is almost impposible to tell to what the ‘this’ refers. I can’t tell if the ‘this’, means
a. the doctor notified him of the difference between a free wellness exam and an exam about a new issue (which Dr. Weir already knew because he knows the system).
b. Dr. Weir was notified and had not known before.
Only b. supports the idea that the public has a false idea about the free wellness visit. But b. is the least likely interpretation of Dr. Weir’s remark. Precisely because it would help his case, if Dr. Weir meant that, I would expect him to say so explicity e.g. ‘as a doctor I thought I understood the ACA, imagine my shock when I went to get my free wellness exam. . . .
2. By Dr. Weir’s own statement, these people expect everything to be free. They are not an example of the public specifically confused becaused they were told one thing about the ACA and learned another.
The other evidence you cite has nothing to do with members of the public thinking few wellness exams under the ACA covered something it, in fact, did not.

Terry:
The $2400 figure has only grown I am sure. The U.S. still spengs thousands more per person on healthcare for care that is at best equal to other countries and more likely significantly inferior. The ACA will not deliver savings on this scale because there is very little government takeover. We will continue to pay our cash to satisfy your delusions.
And last I checked, Iraq was still the worst strategic blunder in U.S. history. Have you noticed the Iraqi governement helping prop up their best friend Assad?http://patdollard.com/2012/10/iran-supplying-assad-with-ground-convoys-through-iraq

“The $2400 figure has only grown I am sure. The U.S. still spengs thousands more per person on healthcare for care that is at best equal to other countries and more likely significantly inferior.”This is called ‘blathering’. It is information free.
Where’s my check? Leave it to someone with DFL in their moniker not to understand how ‘supply and demand’ works, and who believes that, contrary to the lessons of the last century, a government takeover increases efficiency.

“And last I checked, Iraq was still the worst strategic blunder in U.S. history.”More blather. You are entitled to your opinion about Iraq — though I will not that the current secretary of state, and her probable replacement, both appointed by Obama, voted for the Iraq War.
In 2006 it was not a matter of opinion that the Iraq War was lost. You, RickDFL, were simply wrong, as you continue to be on so many, many topics.

“2. By Dr. Weir’s own statement, these people expect everything to be free. They are not an example of the public specifically confused becaused they were told one thing about the ACA and learned another.
The other evidence you cite has nothing to do with members of the public thinking few wellness exams under the ACA covered something it, in fact, did not.”

That’s because that’s what they were told, you moron:You may not yet be aware, though, of another notable improvement to insurance, a change that could save a consumer or family hundreds of dollars a year. Under the new law, insurers must offer preventive services — like immunizations, cancer screenings and checkups — to consumers as part of the insurance policy, at no additional out-of-pocket charge.

A profound insight now flows from the lips of people who previously could only see the fairness argument for universal healthcare, without stopping to consider the fact that the American healthcare industry is as just as wildly out of control today (and for well over a decade) as was America’s sub-prime lending wave and associated financial madness, with its resulting world-crushing crisis.

America’s healthcare system needs extreme repairs at the microeconomic, competitive, and process levels.

The largest causes of high health care costs in America are as follows:

1. Cartel like control over entry into the medical profession by the AMA, resulting in a severe restriction of the supply of doctors in the US and exorbitant earnings, especially in the specialties. It’s supply and demand that is driving costs.

2. Excessive and unchallenged pushing of unnecessary procedures to those who have health insurance, especially by specialists, but also by primary care doctors who are referring patients within the same economic enterprise.

3. Zero economic incentives for preventative care and screening, except those few cases where a costly procedure can be used.

4. The lack of an economic model to incentivize and finance successful preventative care, and therapeutic innovations which are not annuity-producing drugs or high-ticket devices.

5. A cynicism towards patients bred by decades of unlawful medical malpractice litigation deliberately facilitated by the corrupt racketeering enterprise which America’s state courts and judiciary have devolved into being: partners in crime with America’s 1.1 million lawyers who are in fact their colleagues. This cynicism has resulted in excessive costly diagnostics, and doctors favoring interventions which keep the doctor safe from litigation while in many cases increasing the statistically expected level of patient morbidity and mortality.

6. A failure to process reengineering normal, routine medical care in a way which could easily save enormous direct and indirect costs.

Will you indulge me just one more Nazi reference on this day after the 70th Anniversary of the release of “Casablanca” RickDFL? It’s Dr. “Weiss” not Dr. “Weir”. I know – Goldberg, Iceberg, what’s the difference?
You asked for ‘evidence’ that people were disappointed in what was the subject of Mitch’s post – “It’s Only Free If You’re Not Getting Sick”. Do you require names of the complainers in Dr. Weiss’ office? As noted above, patient confidentiality likely prevents him from releasing names. He noted himself, which you dismiss as unlikely, because being the ‘rational’ person you are, you know what is in his heart/mind and not what he wrote and put his name to.
I searched for articles regarding implementing the ‘free wellness visit’ as required by the ACA. The problem – that was the subject of Dr Weiss’ article – is that many Medicare patients misunderstood what the wellness visit included. It became such an issue that the American Association of Family Providers (AAFP) took the trouble to publish a standardized response / patient notification for their membership (provided at the link and excerpted above). Don’t know what the AAFP’s ‘true’ motivations were – only ‘rational’ people like you RickDFL can read minds and hearts so well – but I imagine it’s because lots of patients believed that they weren’t getting what the Obama Administration including Secretary Sebelious promised them and were complaining about it. The fact that people were confused about what the ‘free wellness visit’ included isn’t necessarily the Administration’s fault – they can’t help it if people don’t read the fine print in a >1,500 page law that many members of Congress didn’t bother to read either before passing it – but it is an expected result when government promised a great new ‘free’ benefit, and created expectations that it couldn’t fulfill. Dr Weiss merely pointed out that this has become a problem in his practice because he, not President Obama or Secretary Sebelious, is on the receiving end of the patients ire.
I’m hoping today goes better for you RickDFL. Who knows, maybe Brit Hume will keel over.

By the way it wasn’t just the patients who were confused. As noted in one of the links above, the practitioners office’s were confused as well. When the ‘free wellness visit’ commenced in Jan ’11, many were doing their practices standard wellness exam only to learn after the fact that Medicare was only paying for a few services (noted in the excerpt above) and by paying – they were going to do so >90 days after services rendered. Not sure whether these doctor’s office managers meet RickDFL’s definition of ‘rational’ or not, but if they didn’t know – because HHS didn’t know – perhaps the blame lies with the competence of the people at HHS in charge of the implementation of the ACA.